Characterizing Anxiety at the First Encounter in women presenting to the urogynecology clinic: the CAFÉ Study. Journal Article

Authors: Pham, TT; Chen, YB; Adams, W; Wolff, B; Shannon, M; Mueller, ER
Article Title: Characterizing Anxiety at the First Encounter in women presenting to the urogynecology clinic: the CAFÉ Study.
Abstract: BACKGROUND: Clinically based anxiety questionnaires measure 2 forms of anxiety known as state anxiety and trait anxiety. State anxiety is temporary and is sensitive to change, while trait anxiety is a generalized propensity to be anxious. OBJECTIVE: Our study aims to characterize the reasons for anxiety among women presenting for an initial consultation for their pelvic floor disorders, to measure change in participant state anxiety after the visit, and to correlate improvement in anxiety with visit satisfaction. STUDY DESIGN: All new patients presenting to our tertiary Urogynecology clinic were invited to participate. Following consent, participants completed pre- and post-visit questionnaires. Providers were blinded to pre and post-visit questionnaire responses. The pre-visit questionnaires included the Pelvic Floor Distress Inventory (PFDI), Generalized Anxiety Disorder-7 (GAD-7) and the 6 item short form of the Spielberg State Trait Anxiety Inventory (STAI-Y6). Participants were also asked to list their pre-visit anxieties. The post-visit questionnaires comprised of the STAI-Y6, patient global impression of improvement (PGI-I) of participant anxiety, patient satisfaction, and the participant's perception of whether her anxiety was address during the visit. The anxieties listed by participants were then reviewed independently by 2 of the authors and categorized. A separate panel arbitrated when there were disagreements among anxiety categories. RESULTS: Fifty primarily Caucasian (66%) women with a median age of 53 years (IQR: 41-66) completed the study. The visit diagnoses included: stress urinary incontinence (54%), urge urinary incontinence (46%), myofascial pain (28%), pelvic organ prolapse (20%), and recurrent urinary tract infection (12%). Less than a quarter (22%) of participants had a history of anxiety diagnosis. The average pre-visit STAI-Y6 score was 42.9 (SD=11.98) which decreased by an average of 12.60 points post-visit (95% CI: -16.56 to -8.64, p.001). Post-visit decreased anxiety was associated with improvements in the PGI-I anxiety (p.001) and participants' perception that their anxiety symptoms were completely addressed (p=.045). The most reported causes for consultation related anxiety were: lack of knowledge of diagnosis and ramifications, personal or social issues, and fear of the physical exam. Participants reported that improvements in anxiety were related to patient education and reassurance, medical staff appreciation and acceptable treatment plan. Participants reporting complete satisfaction demonstrated a greater decrease in post-visit STAI scores compared to participants not reporting complete satisfaction (p=.045). Changes in the STAI-Y6 score were not associated with the PFDI (p=.35) or GAD-7 scores (p=.78). CONCLUSION: Women with the highest satisfaction following their initial Urogynecology visit also demonstrate the largest decreases in anxiety following the visit. Changes in anxiety scores were not correlated with the PFDI or with measures of generalized anxiety (GAD-7). Recognizing and addressing patient anxiety may help physicians better treat their patients and improve overall patient satisfaction.
Journal Title: American Journal of Obstetrics and Gynecology
ISSN: 1097-6868; 0002-9378
Publisher: Mosby, Inc  
Date Published: 2019
LUC Authors
  1. Elizabeth Mueller
    54 Mueller
  2. Bill Adams
    64 Adams
Related LUC Article